Theoretical aspect of how to perform neurodynamics; - treatment techniques - progression

1. Neurodynamics-III
Radhika Chintamani

2. CONTENTS
 Mechanical interface treatment technique:
Openers and Closers.
 Neural component: sliders, tensioners,

3. Treatment techniques for mechanical interface
1. Openers: produces opening action around the nervous system and
consists of movements of joints, muscles and fascia. For eg: if a muscle
is inducing any kind of tension/pressure on the nervous system, then the
muscle is released so that, the pressure over the nerve is relieved.
There are two types of openers:
A. Static: Maintained in the open position for certain period of time, thus
enabling blood flow to return to neural tissue so that oxygenation is
improved, hence duration is important in neurodynamics.
B. Dynamic: involves passive or active movements in the opening direction
and naturally involves repeated movements.

4. Reduced opening dysfunctions
LEVEL
S
TREATMENT
TECHNIQUES
Effects Note
1 Mobilizations in
the opening
direction.
Increased space around the
neural tissue in static
position
Reassessment mandatory
2 The distance in the
range is increased:
let it be any
technique;
maitalnd grade is
increased,
mulligan: range is
increased and
SMWAM/LM: The
range is increased.
Maintained space around
neural tissue to move while
moving the upper or lower
limbs or the spine.
Reassessment manadatory

5. Excessive opening dysfunctions
 States instability of neural tissue or dynamic control of the
mechanical interface. Hence treatment is at motor control and
stability paradigms.
 Core strengthening is the best way to attain stability at Lx
region
 Static exercises are the best known way to attain stability at
neck region.
 If severe pain persists on movement with instability: initially
follow electrotherapy strictly and later statics can be started.

6. 2. Closers: these techniques produce a closing action around the
neural tissue. Can be in the form of flexing or extending a joint or
contracting or stretching a muscle. Eg: closing technique of a nerve
root will be ipsilateral side flexion.
Two types of closer:
A. Static: maintenance of closed position of the nerve rootlet:
usually not used as treatment technique; as the constant
maintenance of pressure for long duration leads to neural
ischaemia.
B. Dynamic: repeated movements for certain number of times

7. Reduced closing dysfunctions
LEVEL
S
TREATMENT
TECHNIQUES
Effects Note
1 Interface opening
techniques: Static:
for 30-60 seconds
(if symptoms
increase during the
therapy=stop the
therapy; if no
change= repeat the
procedure for 2-3
times)
Reduces venous
congestion
Improves arterial
blood flow
Attains certain
stability of the neural
tissue due to
maintenance of
certain position.
If first application of static opener produces
dynamic result; then don’t repeat it on the
same day.
Reassessment mandatory
At high level 1, the opener becomes
dynamic and
is effectively a mobilization in the opening
direction.
The range at which the technique is
performed is of
course based on the patient's response but
usually it
is applied in the mid-range and can be
progressed
toward the outer range.
2 Several small
movements in
closing direction
Level 1
improvement seen
move towards the
pathomechanics
level2
Reassessment manadatory

8. Excessive closing dysfunctions
 States instability of neural tissue or dynamic control of the
mechanical interface. Hence treatment is at motor control and
stability paradigms.
 Core strengthening is the best way to attain stability at Lx
region
 Static exercises are the best known way to attain stability at
neck region.
 If severe pain persists on movement with instability: initially
follow electrotherapy strictly and later statics can be started.

9. Treatment techniques for neural component
1. Sliders: Sliding the neural component
one ended or two ended.
One ended Two ended
Moves the neural
structures with the use
of body movements at
one end of the neural
system.
Eg: Median nerve
mobilization technique
in supine.
Produced by applying
tension at one end of
the nervous system
while letting it go on the
other end. This permits
the nerve tissue to
move towards the side
at which the movement
is initiated.
Eg: two ended caudad
slider

10. When to apply sliders???
I. When the key component is pain: because:
i. The technique milks the nerve of the inflammatory exudate
and produces increased blood flow, thus increasing
oxygenation.
ii. Movement induced may help in pain reduction
II. Condition involving specific neural sliding dysfunction: that
is positive sign on neural tension provocating tests.

11.  Technique and dosage:
Slider technique is large amplitude so as to ensure the neural structure
under consideration returns frequently towards its resting position.
(a reason for pain modulation and improvement I
neurophysiological mechanisms)
Slider performed once reassess perform for 3-6times a day
depending on pain perception by the subject reassess again
wait for 24 hours reassess symptom reduced perform the
same dosage again symptom retuned to same but not increased;
increase the dosage to 7-8 times check again and if symptom
increased stop the therapy.

12. Treatment techniques for neural component
2. Tensioners: inducing the tension within
neural tissue which increase mostly at
the outer range (peripheral).
One ended Two ended
Mobilization can be
performed only at the
outer range where the
tension : movement
ratio in the neural tissue
is high.
The Neural tension
provocating test acts as
the treatment here.
Mobilization of nerve is
performed at both the
ends of the nerve and
tension is induced such
that the spinal
component as well as
neural component both
are stretched.

13. When to apply sliders???
I. Only in tensioner dysfunctions.
II. Often, this is followed by sliders for the reason that these
produce maximum adverse reactions.
III. Anti-tenioner applied at level 1 tension dysfunction so as
not to provoke symptoms and indeed reduce the tension.
IV. When there is reduced sensitivity to tension
V. Improvement in neural viscoelastic behavior

14.  Technique and dosage:
Tensioner applied once reassess perform for 2-3times a day
(depending on pain perception:: the stretch induced should be in
limited range) reassess again wait for 24 hours reassess
symptom reduced perform the same dosage again symptom
retuned to same but not increased; increase the stretch range not the
dosage or duration of stretch  check again and if symptom
increased stop the therapy.
Note:
i. Do not increase the hold time of the stretched position .
ii. Do not induce the tension rapidly

15. Progression: first word: limbs and second
word: spine
1. Position away, move away: both
are away from the pain
Improves the pathophoysiology
in the nervous system, hence the
techniques that do not evoke the
symptoms are used.
Move/Position the nervous
system both spine and limbs
(peripheral nervous system)
away from the offending
dysfunction.
Entire neural column is in
shortened position

16. 2. Position toward, move away:
limbs are towards pain and
spine is away from the pain
It is the progression of point 1,
stating that, if the symptoms
are reduced, position the
neural element or the limbs in
the direction of pain but
move the spine away from
the pain inducing position.
Spine is in relaxed
position and limb is into
tension position

17. 3. Position away, move
toward: the limbs are in
relaxed position and spine
is in tension
here, the limbs are moved
away from the pain but
spine is positioned in
direction of pain
Spine is in tension position
and limbs are relaxed: in
the picture, though both are
stretched out check the
angle of hip flexion-Lateral
Rotation and abduction in
the next picture and
compare: the angle varies
for the stretch induced.

18. 4. Position toward, move
toward away: Both limbs
and spine are in stretched
position
 With this system, the neural
structures are gently and
sensitively moved toward
the problematic mechanisms
in an incremental and
systematic way that attacks
the causative
neuropathodynamics,

19. THANK YOU